Striking an unhealthy note: Citizens' views on health and health services

Far fewer citizens are using government health facilities in 2017 (47%) compared to 2016 (74%). Citizens using private or NGO facilities rose at the same time from 16% in 2016 to 34% in 2017. 

Citizens are also less satisfied with the facility they use most often. Between 2016 and 2017, citizens’ approval of the convenience of facilities’ locations has dropped from 70% to 48%, their approval of the facilities’ cleanliness declined from 83% to 63%, the availability of medical staff from 62% to 48% and their satisfaction with waiting times from 52% to 46%.

One area that more citizens seem happier with is the availability of medicine which rose from 41% of citizens reporting being satisfied to 49% this year. 

These findings were released by Twaweza in a research brief titled Striking an unhealthy note: citizens’ views on health and health services. The brief is based on data from Sauti za Wananchi, Africa’s first nationally representative high-frequency mobile phone survey. The findings are based on data collected from 1,705 respondents across Kenya between July and August 2017.

For citizens, the biggest challenge in the health sector is the lack of medical staff (44%). Other issues such as cost (13%), and distance (8%), getting treatment (8%) and strikes (8%) are mentioned by far fewer citizens.

At the health facilities, most citizens say that health workers explain their diagnosis (86%) and the medicine they prescribe (84%) but far fewer offer the opportunity for patients to ask questions (48%). Asking questions is an important way for patients to ensure they have understood both diagnosis and prescription. 

Policy is also not being practiced fully when it comes to exempt groups. Although they should be getting treatment for free, many pregnant women are required to pay for care (29%) as are children under five diagnosed with malaria (34%).

When it comes to access to health services, medical insurance can help people to get the right care. However, only 32% of Kenyans have medical insurance, a proportion that is unchanged from 2016 (31%). Men are more like to have insurance than women (36% vs. 29%), as are urban residents compared to their rural compatriots (37% vs. 29%). Wealthy citizens are much more likely to have insurance than poor ones (58% vs. 13%). This is unsurprising since 40% of citizens say they do not have insurance because of the cost.

Traditional medicine also plays a role in addressing people’s illnesses. One in four Kenyans (23%) report having sought help from a traditional healer at some point. The poor (31%) are much more likely to have done so than the rich (17%). Citizens also have a reasonable level of confidence in traditional medicine when it come to treating malaria (18% say always / often), erectile disfunction (17%), seduction (12%) and work success (11%).

Despite this level of use of and faith in traditional healers, Kenyans are uncertain as to how they fit into society. Although a high proportion of people could not choose (19%), citizens are split between whether traditional medicine is linked to withcraft (36%) or not (45%). Citizens are clear, however, on the role of traditional medicine which they see as a good alternative when modern medicine has failed (39%) rather than as useful all the time (12%).


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